- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $7,943.28 / $13,182.57
| Facility | | $1,023.29 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,023.29 / $3,548.13
| Professional | | $676.08 | $1,023.29 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,318.26 / $2,041.74
| Professional | | $741.31 | $1,318.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,479.11 / $1,737.80
| Professional | | $1,122.02 | $1,479.11 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,122.02 / $7,079.46
| Facility | | $691.83 | $1,122.02 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,412.54 / $2,137.96
| Professional | | $1,096.48 | $1,412.54 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,445.44 / $1,479.11
| Facility | | $1,202.26 | $1,445.44 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,148.15 / $1,778.28
| Facility | | $724.44 | $1,148.15 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $1,412.54 / $1,995.26
| Professional | | $79.43 | $1,412.54 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,912.51 / $10,715.19
| Facility | | $6,606.93 | $8,912.51 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,513.56 / $2,187.76
| Professional | | $1,318.26 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $9,549.93 / $12,882.50
| Facility | | $1,995.26 | $9,549.93 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,445.44 / $1,995.26
| Professional | | $977.24 | $1,445.44 | $1,995.26 |